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18 t m c » p u l s e | j u n e 2 0 1 9 B y C i n d y G e o r g e N avigating a runway seems natural for Madilyn Jenkins. She walks. She runs. She jumps. The 9½-year-old places a hand on her hip as she prances, expressing her personality and even humming a song. Yet on this walkway, she's a superstar and a patient—the center of clinical attention—and the beneficiary of innovative technology that will determine how to improve her movements despite the effects of cerebral palsy. As she advances along a path of mint green force plates at Shriners Hospitals for Children - Houston, data is collected from her steps while 3D motion capture cameras record numerous aspects of her movements. "This is basically a computer lab. We use computers to quantify motion and movement," said Annabelle Relf, D.P.T., one of several physical therapists who work in the motion analysis center. "When someone has a full motion analysis study in centers like ours and we do all the data collec- tion, we can say, yes, we think these muscles are tight, these bones are rotated and you should do this and you shouldn't do this." The MAC Using data beyond a clinical exam to evaluate children with movement disorders began at Shriners Houston in 1978. At that time, the lab used a basic video camera to capture locomotion and electromyography, or EMG, to test the electrical energy of muscles. Today, the motion analysis center, known as "the MAC," uses the same technical special effects employed by animators in movies and video games to calculate potential therapeutic and sur- gical interventions for children ages 4 to 18. The MAC features foot pressure analysis mats reminiscent of kiosks in drug stores that sell shoe inserts, and a mask for metabolic testing to mea- sure how much energy is expended in movement. Instead of creating Hollywood blockbusters, the center uses this suite of computers, cameras and other specialized equipment as a collective diagnostic tool. The lab is staffed by physical therapists, a biomedical engineer, a lab coordinator and a technician. This team runs the motion studies, spends weeks crunching the data and then shares its findings in formal reports for "interpretation sessions" with orthopedic surgeons. "The complication that the children with cerebral palsy have is that sometimes the walking problem is very complex and you need all the data to be able to make decisions," said physical therapist Rebecca Case, the hospital's administrative director of rehabilitative services, which includes the motion center. "We want to improve their lives now, but we are aiming at when they graduate from Shriners that they're as functional as they can be and that they can be successful adults." Most of the children examined in the lab for major studies, which take 2 to 3 hours, have cerebral palsy—the most common childhood movement disorder, according to the Centers for Disease Control and Prevention. Beyond gait A surgical plan can change based on gait analysis, which can clarify the complexity of a case and lead to less trauma for the patient. "For an experienced individual in gait dysfunc- tion in a child with cerebral palsy—for example, for me—I would say that the motion lab changes what I would plan to do 20 to 25 percent of the time," said pediatric orthopedic surgeon Douglas Barnes, M.D., the MAC's medical director for the last two decades and the Shriners Houston chief of staff. "For me, it is invaluable." Innovation at the lab has advanced beyond legs, he added. "We are developing capabilities of refining The motion analysis center at Shriners Houston calculates therapeutic and surgical interventions Going Through the Motions B y C i n d y G e o r g e m o t i o n a n a ly s i s